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Trends in the Utilization of Recommended Clinical Preventive Services, 2011–2019

  • Suhang Song
    Correspondence
    Address correspondence to: Suhang Song, PhD, Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Northeast, Mailstop H21–11, Atlanta GA 30329.
    Affiliations
    Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia

    Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
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  • James E. Kucik
    Affiliations
    Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
    Search for articles by this author

      Introduction

      The Patient Protection and Affordable Care Act requires many health insurance plans to cover certain clinical preventive services in network with no cost sharing. This study describes the utilization trends of 8 clinical preventive services by insurance status and analyzes utilization disparities.

      Methods

      Data were collected from 2011 to 2019 through the Behavioral Risk Factor Surveillance System and were analyzed in 2021. Logistic regression and generalized linear modeling were fitted to calculate the absolute and relative differences by insurance status, respectively. Annual percentage point change was applied to assess the trends in utilization and the relative difference.

      Results

      Trends in utilization ranged from an annual percentage point change high with zoster vaccination of 8.03 (p<0.01) and a low with cervical cancer screening of −1.01 (p<0.01). Trends (except for HIV testing) were consistently substantially lower among the uninsured. Utilization among all participants increased for 4 clinical preventive services, although larger increases were observed among the uninsured for breast and colon cancer screenings. The utilization of cervical cancer screening decreased, and the utilization of the other 3 services did not change significantly. The relative difference between the insured and the uninsured decreased modestly with the greatest reductions observed for breast cancer screening and zoster vaccination, whereas increases were observed for HIV testing.

      Conclusions

      Despite the reduction of cost barriers for the insured, there were larger increases in utilization among the uninsured, and a narrowed gap was observed over time for some services. Ongoing efforts to monitor the trends in clinical preventive services utilization may help identify and evaluate the strategies designed to increase their use.
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